Section 616C.103 - Rating evaluation of injured employee: Requirements; award of payment; appeal1. For purposes of determining whether an injured employee is stable and ratable and entitled to an evaluation to determine the extent of any permanent impairment pursuant to this section and NRS 616C.490, the Division interprets the term: (a) "Stable" to include, without limitation, a written indication from a physician or chiropractic physician that the industrial injury or occupational disease of the injured employee: (1) Is stationary, permanent or static; or(2) Has reached maximum medical improvement.(b) "Ratable" to include, without limitation, a written indication from a physician or chiropractic physician that the medical condition of the injured employee may have:(1) Resulted in a loss of motion, sensation or strength in a body part of the injured employee;(2) Resulted in a loss of or abnormality to a physiological or anatomical structure or bodily function of the injured employee; or(3) Resulted in a mental or behavioral disorder as the result of a claim that has been accepted pursuant to NRS 616C.180.2. If an insurer proposes that an injured employee agree to a rating physician or chiropractic physician chosen by the insurer, the insurer shall inform the injured employee in writing that the injured employee:(a) Is not required to agree with the selection of that physician or chiropractic physician; and(b) May request that the rating physician or chiropractic physician be selected in accordance with subsection 3 and NRS 616C.490, as amended by section 17 of Senate Bill No. 274, chapter 535, Statutes of Nevada 2023, at page 3630.3. An insurer shall comply with subsection 2 of NRS 616C.490, as amended by section 17 of Senate Bill No. 274, chapter 535, Statutes of Nevada 2023, at page 3630, within the time prescribed in that subsection for the scheduling of an appointment, by: (a) Selecting a rating physician or chiropractic physician in accordance with the procedures for the random selection of a rating physician or chiropractic physician set forth in section 7 and requesting that the selected rating physician or chiropractic physician evaluate the injured employee and determine the extent of any permanent impairment or, if the injured employee and insurer have agreed to a rating physician or chiropractic physician pursuant to subsection 2 of NRS 616C.490, as amended by section 17 of Senate Bill No. 274, chapter 535, Statutes of Nevada 2023, at page 3630, by submitting a completed form designated in NAC 616A.480 as D-35, Request for Assignment of Rating Physician or Chiropractic Physician, which identifies the rating physician or chiropractic physician to the Administrator within 30 days after the insurer has received the statement from a physician or chiropractic physician that the injured employee is ratable and stable; and(b) Mailing written notice to the injured employee of the date, time and place of the appointment for the rating evaluation.4. At least 3 working days before a rating evaluation, the party that requested the rating evaluation must provide to the assigned rating physician or chiropractic physician: (a) All reports or other written information concerning the injured employee's claim produced by a physician, chiropractic physician, hospital or other provider of health care, including the statement from the treating physician or chiropractic physician that the injured employee is stable and ratable, surgical reports, diagnostic, laboratory and radiography reports and information concerning any preexisting condition relating to the injured employee's claim;(b) Any evidence or documentation of any previous evaluations performed to determine the extent of any of the injured employee's disabilities and any previous injury, disease or condition of the injured employee that is relevant to the evaluation being performed;(c) The form designated in NAC 616A.480 as C-4, Employee's Claim for Compensation/Report of Initial Treatment;(d) The form designated in NAC 616A.480 as D-35, Request for Assignment of Rating Physician or Chiropractic Physician; and(e) The form designated in NAC 616A.480 as D-36, Request for Additional Medical Information and Medical Release.5. An insurer shall pay for the cost of travel for an injured employee to attend a rating evaluation as required by NAC 616C.105.6. Except as otherwise provided in subsection 7, if the rating physician or chiropractic physician finds that the injured employee has a ratable impairment, the insurer shall, within the time prescribed by NRS 616C.490, offer the injured employee the award to which he or she is entitled. The insurer shall make payment to the injured employee: (b) If there is any child support obligation affecting the injured employee, within 35 days, after the later of the date on which the insurer offers the award or the date on which it receives the properly executed lump-sum award papers from the injured employee or his or her representative.7. If the insurer disagrees in good faith with the result of the rating evaluation, the insurer shall, within the time prescribed in NRS 616C.490: (a) Offer and pay the injured employee the portion of the award, in installments, which it does not dispute;(b) Provide the injured employee with a copy of each rating evaluation performed of the injured employee; and(c) Notify the injured employee of the specific reasons for the disagreement and the right of the injured employee to appeal. The notice must also set forth a detailed proposal for resolving the dispute that can be executed in 75 days, unless the insurer demonstrates good cause for why the proposed resolution will require more than 75 days.8. The injured employee must receive a copy of the results of each rating evaluation performed of the injured employee before accepting an award for a permanent partial disability.9. As used in this section, "lump-sum award papers" means the following forms designated in NAC 616A.480, as appropriate: (a) D-10a, Election of Lump Sum Payment of Compensation.(b) D-10b, Election of Lump Sum Payment of Compensation for Disability Greater than 30 Percent.(c) D-11, Reaffirmation/Retraction of Lump Sum Request.Nev. Admin. Code § 616C.103
Added to NAC by Div. of Industrial Insurance Regulation, eff. 10-26-83; A 2-22-88; 9-7-88; 8-30-91; A by Div. of Industrial Relations by R009-97, 10-27-97; R006-97, 12-9-97; R090-99, 10-28-99; R090-99, 10-28-99, eff. 1-1-2000; R105-00, 1-18-2001, eff. 3-1-2001; R118-02, 9-7-2005; R108-09, 6-30-2010; A by R134-20A, eff. 9/20/2022; Added to NAC by Div. of Industrial Relations by R134-20RA, eff. 12/19/2022; A by R032-21A, eff. 8/1/2023; A by R076-23A, eff. 10/9/2024NRS 616A.400, 616C.490, as amended by section 17 of Senate Bill No. 274, chapter 535, Statutes of Nevada 2023, at page 3630